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Treatment Of Zygomatic Fractures |
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Non surgical Management Reserved for 1. Minimal/Undisplaced fractures 2. Patients with medical contra-indications 3. The very elderly
Indications for surgery 1. Cosmetic deformity 2. Impaired mandibular movement 3. Diplopia 4. Infra orbital para/anaesthesia not certain that surgery improves recovery
Timing of surgery As soon as possible elevation becomes difficult after 14 days. Long delays leads to fibrosis and resorption of fracture margins, increases difficulty and decreases stability Delays sometimes necessary to allow dispersion of gross oedema and a proper ophthalmic examination usually includes a HESS chart A zygomatic fracture will be firmly united in 3-4 weeks
Surgical Approaches to the Zygoma 1. Temporal fossa (Gillies) approach 2. Intra-oral 3. Percutaneous: stab incision/eyebrow incision / bicoronal flap
Stability of the fracture reduction depends on the muscle pull and attachments and the adequacy and accuracy of bony apposition at fracture sites
Fractures which may require fixation 1. Separation of F-Z suture and disruption of infraorbital margin 2. Comminuted fractures 3. Arch fracture 4. Delayed treatment
1. Osteosynthesis by direct wiring or placement of plates 2. Antral support: pack/balloon or wedge 3. External/Internal pin fixation
Complications of Untreated or Poorly Treated fractures 1. Flat cheek 2. Altered papillary level 3. Diplopia
Complications
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